Retrospective analysis of clinical outcomes in the management of patients with floating aortic thrombus

Introduction
Floating aortic thrombus is a rare vascular presentation. Little is known about the underlying responsible pathology and natural history of this underreported condition.
Patients and methods
A retrospective analysis was done to review all cases diagnosed with idiopathic floating aortic thrombus, presented to our hospitals during the period from March 2016 to March 2021. All collected material were processed to analyze demographic data, presenting symptoms, risk factors, diagnostic modalities, management strategies, and outcome over mid-term and long-term follow-up visits.
Results
This study included nine patients, four (44.4%) males and five (55.6%) females. Mean age: 63 ± 12.2 year; one patient was under active cancer treatment and another patient was recently recovering from coronavirus disease 2019 infection. All patients had average follow-up for 3–36 months. Most of the patients had the thrombus at the infrarenal aortic segment (three patients), while two had the thrombus at the distal aortic arch; two at the thoracic segment and two at the visceral aortic segment. All patients were presented with manifestations of distal arterial embolization. Extremity embolization was seen in seven (77.8%) patients and visceral embolization in two (22.2%) patients. All patients were started on unfractionated heparin, five (55.6%) patients needed surgical and or endovascular interventions during hospitalization, while four (44.4%) patients were managed conservatively. Two (22.2%) patients needed initial surgical thrombectomy for acute mesenteric/limb ischemia, while three other patients needed percutaneous aspiration thrombectomy with balloon angioplasty and stent insertion. Inhospital distal embolization occurred in two (22.2%) patients for whom stent grafts of the proximal aorta were inserted to exclude floating thrombus. All patients showed thrombus regression over a period of 1–3 months with no recurrent embolic events on successive follow-up.
Conclusion
Floating aortic thrombus (free-floating thrombus) is a serious condition. Initial anticoagulation is followed by revascularization of the ischemic organ if applicable followed by definite treatment of the thrombus with endovascular catheter-based approaches if possible has an overall good outcome.